CT diagnosis and localization of rupture of the bladder in children with blunt abdominal trauma: significance of contrast material extravasation in the pelvis

Abstract

Objective: The purpose of this study was to determine the utility of CT performed with maximal bladder distension in showing extravasation of IV contrast material as a means of detecting and localizing bladder rupture in children after blunt trauma.

Materials and methods: Seven of 1500 consecutive children who had IV contrast-enhanced CT of the abdomen after blunt trauma had a rupture of the bladder proved at surgery (five patients) or by clinical and imaging findings (two patients). The scanning protocol in all patients included occlusion of the Foley catheter if present and a 5-min delay after IV injection of contrast material prior to scanning the pelvis. The CT scans of all 1500 children were prospectively evaluated for the presence and location of extravasated contrast material in the pelvis.

Results: Extravasated IV contrast material in the pelvis was noted in all seven children with bladder rupture (intraperitoneal in four, extraperitoneal in three) and two of 1493 children without bladder rupture (extraperitoneal in both). Both children with contrast material extravasation who did not have bladder rupture had a renal injury. The location of the rupture (intraperitoneal or extraperitoneal) could be determined from the distribution of extravasated contrast material in the pelvis seen on CT scans.

Conclusion: The use of a scanning delay at CT prior to imaging the pelvis showed extravasation of IV contrast material in all seven children with bladder rupture. Intraperitoneal and extraperitoneal bladder rupture could be differentiated on the basis of the distribution of extravasated contrast material seen on CT scans.